Background and aims Myotonic dystrophy type 1 (DM1) or Steinert’s disease is an autosomal dominant neuromuscular disease characterized by muscle weakness mainly of distal, axial, facial, pharyngeal and respiratory muscles. It is also accompanied by cardiac arrhythmias.
The risk of general anesthesia in these patients includes cardiac rhythm disturbances, myotonic crisis and respiratory complications with increased sensibility to opioids, hypnotic and muscle relaxants; therefore, short-acting agents and regional anesthesia are frequently used.
Methods We present a 43-year-old female with diagnosis of DM1 who underwent elective shoulder arthroscopy. She showed muscle weakness in upper extremities and recurrent myotonia but no cardiac or respiratory symptoms.
We performed an ultrasound-guided interscalene brachial plexus block with 5 ml of 5% lidocaine aiming for minimal or short-timed phrenic nerve blockade. In addition we performed an ultrasound-guided suprascapular nerve and supraclavicular nerve block to provide postoperative analgesia with 15 ml and 3 ml of 0,5% bupivacaine, respectively. We observed no hemi-diaphragmatic paresis by M-mode ultrasonography. Due to patient anxiety, we induced general anesthesia with propofol and remifentanil perfusion and a single dose of rocuronium. We monitored ASA standard parameters, temperature and neuromuscular blockade (NMB) with TOF-Cuff® monitor.
Results After surgery, NMB was reversed with sugammadex 2 mg/kg (T4/T1= 100%) and the patient was extubated without respiratory complications. Visual analogue scale (VSA) for pain was 0/1 immediately afterwards and 1–2/10 after 24 hours. No rescue analgesia was requested.
Conclusions It is possible to perform interescalenic brachial plexus blocks with low-volume and high-concentration of LA for shoulder arthroscopy with good intraoperative analgesia and minimum respiratory complications in patients with DM1.
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